- Myths and Facts About Syphilis
- Myth 1: Syphilis Is a Thing of the Past
- Myth 2: Syphilis Makes You Go Insane
- Myth 3: Syphilis Is Incurable
- Myth 4: You Can Tell if You Have Syphilis
- 3 Myths From Earlier Times
- What Is Syphilis?
- What Are STDs?
- How Do People Get Syphilis?
- What Are the Signs & Symptoms of Syphilis?
- What Are the Signs & Symptoms of Primary Syphilis?
- What Are the Signs & Symptoms of Secondary Syphilis?
- What Are the Signs & Symptoms of Latent Syphilis?
- What Are the Signs & Symptoms of Late Syphilis?
- What Is Neurosyphilis?
- What Causes Syphilis?
- How Is Syphilis Diagnosed?
- How Is Syphilis Treated?
- Can Someone Get Syphilis More Than Once?
- Can Syphilis Be Prevented?
- You’re Spotting—or Appear to Be
- Sex Hurts
- You Feel Flu-y
- MORE: 7 Signs of Infertility You Didn’t Know
- You See Strange Bumps Down There
- You Have Weird Discharge
- You’re Symptom-Free (Yep—Scary)
- 6 Surprising Facts About STDs
- If you have sex — or are planning to — you should read this
- 1. More than 25 different diseases can be transmitted sexually.
- 2. STDs among older adults are on the rise.
- 3. Some STDs — including chlamydia and gonorrhea, which have no symptoms — can affect fertility.
- 4. Condoms don’t provide 100 percent protection from the most common STD: genital herpes.
- 5. Any sexual activity — not just intercourse — can spread STDs, including one that can cause cancer.
- 6. Most people who have herpes have no, or very mild, symptoms.
- Test for the top 7 STDs
- Worry and anxiety
- The Nine Myths of Syphilis
- MYTH #1: Syphilis is a thing of the past.
- MYTH #2: Syphilis is a heterosexual disease.
- MYTH #3: Syphilis can’;t be spread through oral sex.
- MYTH #4: Syphilis is easily spotted.
- MYTH #5: Syphilis is incurable.
- MYTH #6: Syphilis is not dangerous.
- MYTH #7: The cures today can undo any damage caused by syphilis.
- MYTH #8: I’;ve had syphilis, so I can’;t get it again.
- MYTH #9: I’;m not promiscuous. I can’;t get syphilis.
- What Are the Signs and Symptoms of Syphilis?
- STDs You Should Know
- STDs You Should Know More About
- Everything You Need to Know About Syphilis
Myths and Facts About Syphilis
Myth 1: Syphilis Is a Thing of the Past
Fact: “One of the big myths is that syphilis doesn’t exist anymore,” Bogart says. Many people think of syphilis as a disease that happened a long time ago, killed lots of people, but is no longer a worry.
“People will think, ‘Didn’t syphilis go away with the plague?’” says Damian P. Alagia III, MD, the medical director of women’s health for Quest Diagnostics. Like Bogart, he has encountered people who wrongly believe that syphilis is no longer an issue.
In fact, syphilis definitely qualifies as an active concern. “And it is something that you need to think about if you’re sexually active,” Bogart says. She points out that syphilis rates have been increasing in recent years, especially but not only in certain groups.
Year by year, syphilis rates in the United States have been trending upward since the year 2000. Syphilis rates are climbing for people with all sexual preferences, heterosexuals included. But the rates of all STDs, including syphilis, are especially high among men who have sex with men and among people of color. (1)
Elsewhere, in parts of Canada and Europe, syphilis rates have also risen in recent years.
The growing use of hookup apps such as Tinder and Grindr may be one reason for the rising rates of STDs including syphilis, some social scientists say.
Myth 2: Syphilis Makes You Go Insane
Fact: “Before there were treatments for syphilis, which are antibiotics, some very famous people had end-stage syphilis, and one of the symptoms of that is actually insanity,” says Bogart.
But today syphilis is completely curable, especially if it is diagnosed and treated early in the course of the illness. “Most people don’t progress to that end stage unless it’s untreated,” she says.
Myth 3: Syphilis Is Incurable
Fact: “That is just not true,” says Bogart. “Once antibiotics became available, syphilis became completely curable.”
It is true, though, that if a diagnosis comes late in the course of the illness, any organ damage already caused by syphilis may prove irreversible.
Myth 4: You Can Tell if You Have Syphilis
Fact: While you will have some symptoms soon after the infection occurs, you won’t necessarily notice them or recognize them as syphilis. At the location where the bacterium first entered your body, a sore called a chancre will crop up.
“You can miss that sore,” says Bogart. It may be visible if it’s on the penis, but it may not be visible if it’s tucked away inside your anus, vulva, or cervix.
Unlike the shallow, painful, weeping ulcers that are caused by herpes, a chancre that serves as a first sign of syphilis is painless.
“Some people could confuse that for chafing, if they are exercising a lot or bicycling a lot or just having more friction during their sexual relations,” says Dr. Alagia. “They may think that it’s normal and that it just happened. That’s one reason we call syphilis ‘the great pretender.’”
“If you notice anything, any change on your skin or any sore on your penis or anus, get that checked out,” says Bogart. “It could be one of several sexually transmitted diseases, including syphilis. If it is syphilis, the earlier that you catch it and the earlier that you treat it, the better off you will be.”
3 Myths From Earlier Times
Old Myth 1: Sex With a Virgin Cures Syphilis
This myth took hold in the 17th century. Horrifyingly, even today some people believe it. This wrongheaded idea has also shifted over time to include sex with a virgin as a cure for AIDS. As a result, news reports indicate that a growing number of men with AIDS have raped children in South Africa in hopes of a cure.
Obviously, nothing could be further from the truth. Having sex with an uninfected person — sexually experienced or not — simply puts that person at risk of acquiring the infection.
Old Myth 2: Syphilis Can Only Enter a Flaccid Penis
A soft male member “drinks the infection in like a sponge,” wrote François Ranchin, a French physician in the 17th century. This idea ties in with another old myth that ejaculation during sex with a syphilitic woman leaves a man vulnerable to the infection.
In truth, once a man is having sex with an infected partner, he is vulnerable whether he ejaculates or not.
Old Myth 3: Syphilis Is an Inherited Disease
So called “folk wisdom” in Europe maintained that the “syphilitic taint” passed to the sperm or an egg during one sexual encounter. It would infect the person born of that sexual encounter, who could then pass it on to his or her children, and so on through many generations.
It’s now known that this is untrue, although a pregnant woman who has syphilis can pass it to her baby, often with disastrous results.
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What Is Syphilis?
Syphilis is a sexually transmitted disease (STD). Early treatment can cure syphilis (pronounced: SIFF-ill-iss) and prevent long-term problems.
What Are STDs?
STDs (also called sexually transmitted infections or STIs) are infections that spread through sex (vaginal, oral, or anal). Some STDs can spread through close contact with the genitals or body fluids. (Genitals are the sexual or reproductive organs that are on the outside of the body.)
How Do People Get Syphilis?
Syphilis usually spreads by touching a sore (called a chancre ) or wart-like lesions (called condyloma lata) caused by syphilis. This can happen through sex (vaginal, oral, or anal) or close sexual contact.
The chancre or condyloma lata (pronounced: kon-duh-LOW-muh LAH-tuh) may be hard to see, so someone might not know they have them.
An infected pregnant woman can spread the infection to her unborn baby during pregnancy or delivery.
What Are the Signs & Symptoms of Syphilis?
Syphilis has different stages. In the order that they happen, they are:
- primary syphilis
- secondary syphilis
- latent syphilis
- late syphilis (also called tertiary syphilis)
What Are the Signs & Symptoms of Primary Syphilis?
The main symptom of primary syphilis is a one or more chancres (sores). They develop about 3 weeks after someone is infected. The chancres happens where the sexual contact happened (genitals, mouth, or rectal area). They are usually painless.
The chancre goes away in about 3–6 weeks, even without treatment. But without treatment, syphilis will move on to the next stage, secondary syphilis.
What Are the Signs & Symptoms of Secondary Syphilis?
A few weeks to months after the chancre appears, these symptoms can begin:
- rash, often on the palms of the hands and soles of feet
- flu-like symptoms such as fever, headache, tiredness, loss of appetite, muscle aches, joint pain, and sore throat
- swollen glands (lymph nodes)
- wart-like lesions (condyloma lata) in warm, moist areas, such as the mouth and area around the genitalia and anus
- hair loss
Over time, secondary syphilis can liver, kidney, and digestive tract problems.
The symptoms of secondary syphilis will go away. But without treatment, syphilis will move on to the next stage, latent syphilis.
What Are the Signs & Symptoms of Latent Syphilis?
Someone with latent syphilis is infected but does not have any symptoms (“latent” means it’s not obvious or causing symptoms). Syphilis can stay latent for life. Or, it may move to late syphilis.
What Are the Signs & Symptoms of Late Syphilis?
If latent syphilis progresses to late syphilis (also called tertiary syphilis), it causes serious damage to the heart and blood vessels, brain and nervous system, and other organs.
Late syphilis can develop any time from 1–30 years after someone is infected. Even someone who has not had any symptoms of primary or secondary syphilis can progress to late syphilis.
What Is Neurosyphilis?
Neurosyphilis is syphilis that has spread to the brain and nervous system. It can happen during any of the stages of syphilis. People with neurosyphilis can have:
- syphilitic meningitis
- damage to spinal cord
- eye problems that can lead to blindness
What Causes Syphilis?
A type of
called Treponema pallidum causes syphilis.
How Is Syphilis Diagnosed?
To find out if someone has syphilis, health care providers usually do a blood test. Fluid from the chancre also can be tested. Someone who has symptoms of neurosyphilis will get a spinal tap (lumbar puncture). This test collects some fluid from around the brain and spinal cord for testing in a lab.
How Is Syphilis Treated?
Health care providers treat syphilis with
. These medicines are given as a shot or through an IV (a tiny tube that goes into a vein). How long treatment is needed depends on what stage of syphilis someone is in.
Syphilis can be cured. But the medical problems it can lead to — such as dementia, artery damage, or blindness — usually can’t be cured.
After treatment, follow-up testing will make sure that the infection is cured.
All sexual partners should get tested and treated, if necessary:
- For primary syphilis: partners from the last 3 months
- For secondary syphilis: partners from the last 6 months
- For latent syphilis: partners from the last year (because there could have been a chancre or condyloma lata that wasn’t noticed)
Can Someone Get Syphilis More Than Once?
Yes, people can get syphilis again if they have sex with someone who is infected.
Can Syphilis Be Prevented?
The only way to prevent syphilis and other STDs is not to have sex (oral, vaginal, or anal). If someone decides to have sex, using a latex condom every time can prevent most STDs.
Anyone who is sexually active should get tested for STDs every year, or more often if recommended by their health care provider.
Reviewed by: Krishna Wood White, MD, MPH Date reviewed: October 2018
In Canada, the reported rate of infectious syphilis was an all-time low of 0.4/100,000 in 1997 with a dramatic rise to 3.5/100,000 in 2004 (1). The reason for this increase is unclear, although it appears to be associated with unsafe sexual practices especially in men who have sex with men (MSM), illicit intravenous drug use, and concurrent HIV infection (3). Unfortunately, data regarding the incidence of neurosyphilis in Canada is not available. In a systematic review of China’s syphilis seroprevalence from 2000 to 2005, 660/100,000 of premarital individuals were reported to have both a positive screening nontreponemal test (i.e. RPR, Venereal Disease Research Laboratory (VDRL)) and a positive treponemal-based confirmatory test (i.e. Treponema Pallidum Agglutination Assay) (2). In select high-risk groups in China, incarcerated female sex workers, drug users, and MSM had syphilis seroprevalence rates of 12.49%, 6.81%, and 14.56%, respectively (2). New infections can be vertically transmitted from mother to baby or more typically, acquired by sexual contact (4). Syphilis also enhances the transmission of HIV by 3 to 5 times due to inflammation in the genital area and the association with high risk behaviours (5).
Syphilis is caused by the spirochete bacteria Treponema pallidum. The clinical course can be divided into several distinct stages: primary, secondary, early latent, late latent and tertiary stages (6). Primary syphilis manifests as a painless chancre at the site of inoculation, typically involving the penis, vagina, vulva, cervix, anal canal, perianal region, or mouth. Incubation period ranges from 9 to 90 days from initial exposure and the infection resolves spontaneously within 4–5 weeks if untreated (7). Syphilis may recur systemically as secondary syphilis and is characterized by constitutional symptoms (fever, malaise, anorexia), headache, lymphadenopathy, condyloma lata, mucosal ulceration and a generalized, symmetrical macular-papular rash involving the trunk, soles and palms (6). The patient may experience relapsing episodes of secondary syphilis for several years. After spontaneous resolution, the infection enters an early latent stage in which the patient is asymptomatic but has positive serologic testing and remains highly infectious. Beyond one year of latency, the asymptomatic infection is classified as late latent syphilis. Failure to treat may result in progression to the most serious stage called late symptomatic syphilis or tertiary syphilis (6).
If untreated in the latent phase, approximately 40% of patients would then develop tertiary syphilis (4). Manifestations of tertiary syphilis include cardiovascular syphilis, gummatous syphilis and neurosyphilis. Cardiovascular syphilis may occur 15–30 years after primary infection and mainly involve large vessels, resulting in proximal aortic aneurysm, aortic regurgitation and angina (7). Gummatous syphilis presents 3–12 years after primary infection as inflammatory fibrous nodules that are locally destructive (7). These lesions can involve any organ of the body, but usually affect skin or bone. Neurosyphilis may be divided into early and late forms, of which only the latter is considered to be tertiary.
Early neurosyphilis commonly affects the CSF, meninges, and vasculature (8). Manifestations include asymptomatic or symptomatic meningitis and meningovascular disease. Less than 2 years after primary infection, patients may present with asymptomatic meningitis with CSF abnormalities including a reactive VDRL, a lymphocytic pleocytosis, and elevated protein. Lack of treatment at this stage may result in progression toward more serious forms of neurosyphilis. Symptomatic meningitis most often presents in the first year after inoculation. Patients typically complain of headache, confusion, nausea/vomiting, stiff neck and decreased visual acuity. Syphilis may also cause inflammation of the intracranial vasculature and must be part of the differential diagnosis for an ischemic stroke in a young patient. Meningovascular disease may be visualized on angiography showing focal narrowing or occlusion (9).
Common forms of late neurosyphilis affect CNS parenchyma and include general paresis of the insane (also known as general paresis) and tabes dorsalis (8). Both forms have poor prognoses without treatment but are very uncommon in the antibiotic era. General paresis develops 10–25 years after initial infection and manifests as a progressive dementia with symptoms of personality change and poor memory (7). Common abnormal neurologic findings include facial and limb hypotonia, dysarthria, and intention tremor. Patients may exhibit psychiatric symptoms such as depression, mania, or psychosis and may inadvertently be admitted to psychiatry. Tabes dorsalis presents with ataxia and lancinating pains secondary to destruction of the posterior columns and dorsal roots of the spinal cord. The pain affects the limbs, trunk and face and described as sudden, brief and severe. Characteristic Argyll-Robertson pupils may be present – the pupils respond to accommodation and convergence but do not react to light. Other signs and symptoms include paresthesias, severe episodic nausea/vomiting, impaired vibration sense and proprioception, and absent lower extremity reflexes (8).
The diagnosis of neurosyphilis in particular relies heavily on clinical exam, CSF analysis, and risk factors including positive HIV status, multiple sexual partners, illicit IV drug use, MSM, and a previously documented syphilis infection. If a genital lesion is present, dark-field microscopy may reveal spirochetes moving with a spiralling motion (10). Systemic syphilis is detected by screening serum nontreponemal tests (VDRL, RPR) and confirmatory treponemal tests (fluorescent treponemal antibody absorption, FTA-ABS and Treponemal pallidum particle agglutination assay, TPPA). Late neurosyphilis may have nonreactive serum non-treponemal tests. CSF-VDRL is the gold standard for diagnosing neurosyphilis, although it is not as sensitive as the less-specific CSF FTA-ABS (11). CSF demonstrating lymphocytic pleocytosis, high WBC count, and a high protein concentration is consistent with neurosyphilis. In a recent, multi-center prospective study, it was found that patients with serum RPR titres >= 1:32 were highly predictive of also having neurosyphilis (defined as a positive CSF-VDRL or CSF WBC > 20 cells/microliter), regardless of syphilitic stage, HIV status, or previous non-neurosyphilis treatment (12). In HIV-positive patients infected with syphilis, serum RPR titres may be elevated in early HIV infection compared to HIV-negative patients. In late stage HIV infection, serologic response to syphilis may be delayed or absent. These paradoxical findings may be attributed to B-cell hyperfunctioning and failure, respectively (13).
The patient in question presented with an insidious onset of personality change, delusions, and memory loss. The differential diagnosis of these psychiatric symptoms in a 40 year old male includes psychiatric conditions such as schizophrenia, bipolar disorder, and early-onset Alzheimer’s dementia as well as infectious causes such as HIV dementia, CNS tuberculosis, herpes encephalitis, and neurosyphilis, among others. As neurosyphilis is often called “the great masquerader,” it is critical to have this diagnosis on the differential of any patient presenting with insidious onset of psychiatric symptoms with atypical features. Although possible, forty years of age is fairly old for new onset schizophrenia and too young for Alzheimer’s. However, despite the absence of syphilis risk factors outlined above, the presence of frequent headaches and the characteristic Argyll-Robertson pupils in this patient strongly supported the diagnosis of neurosyphilis even before formal investigations were carried out.
The standard of treatment for neurosyphilis is Penicillin G 3-4 million units IV q4h or 24 million units continuous IV infusion for 10–14 days (14). Penicillin G procaine 2.4 million units IM qd plus probenecid 500mg po qid for 10–14 days may be given as an alternative (15). Ceftriaxone 2g IV qd for 10–14 is also an option (14). Follow-up clinical examination and lumbar puncture should be scheduled at 3–6 months after treatment and every 6 months thereafter until the CSF–VDRL becomes nonreactive and the CSF white blood cell count normalizes (8). CSF abnormalities clear typically in 2 years. Prognosis is excellent with early treatment initiation, but can be poor with irreversible brain damage.
You know your body best, right? That means it’s important it’s important to pay attention to what it’s telling you—and all its individual parts, from your breasts to your gut and, of course, your vagina. Tuning in to how you feel down there can help you pick up on the often-sneaky symptoms of sexually transmitted infections.
“The number one message for STI prevention is obviously to have safe sex, but that doesn’t always happen, so make sure you get screened routinely and whenever you have a new partner,” Lauren Streicher, MD, author of Sex Rx: Hormones, Health, and Your Best Sex Ever. Though there can be potentially serious ramifications on your health if STIs are left untreated, there are good therapies to cure or control the conditions, so don’t be afraid to bring them up with your doctor. Either way, here are seven not-so-obvious you should watch out for.
You’re Spotting—or Appear to Be
It’s easy to see a little blood in your undies in the middle of the month and think, huh, weird, I’m spotting. But mucous-y or runny discharge that’s a bit bloody may be an indication of chlamydia or gonorrhea, says Dr. Streicher. Of course, if you do notice this, don’t panic—but do get yourself to a doc if it persists. Other signs of these STIs include burning when peeing, so if you’re also experiencing that, push the visit to the top of your to-do list.
Sex generally should feel much more oh yeah than oh no. Know that if you’re feeling pain or discomfort during penetration, it’s possible you may simply be dry down there and in need of a good lube. But if that doesn’t do it and intercourse is still painful on a regular basis and it doesn’t seem to be related to anything you’re aware of (like recovering from a yeast infection or UTI), you should definitely talk to your doctor about testing—especially if you’re spotting afterward, another possible STI red flat.
You Feel Flu-y
Fever, body aches, swollen glands, and other flu-like symptoms are additional potential signs of the herpes virus. These will pop up two to 12 days after your hookup, according to WomensHealth.gov. Also be on the lookout for additional symptoms like vaginal discharge, itching, and burning.
MORE: 7 Signs of Infertility You Didn’t Know
Maybe you’re feeling unusually achey before or during your period and don’t know why. Or you could swear you have a bladder infection. Abdominal pain can be another nondescript sign of an STD, particularly in gonorrhea, so if the symptom persists without explanation, get to your OB, stat.
You See Strange Bumps Down There
Before you jump to conclusions, know that it could be genital herpes, but it could also be something incredibly benign, too. “When women first start seeing a new partner, they might shave or wax, which can irritate the area and cause ingrown hairs,” explains Dr. Streicher. Or, she says, you remove the hair and notice a mark you never have before. To you, this may look like a sore worth freaking out over. Either way, get clarity at your doc’s office: For the proper diagnosis, “the best time to be seen is when the sore is still there,” she says. So don’t wait—make that appointment now.
You Have Weird Discharge
This is often a symptom of bacterial vaginitis, an infection that’s not technically an STI, but is associated with sex and can be really painful and uncomfortable. “Sex can throw off the pH or balance of bacteria in your vagina, leading to BV,” explains Dr. Streicher. That causes symptoms that can be easily confused with an STI or yeast infection, like itching, burning, and an odorous discharge. If your doc concludes you have BV, she’ll give you antibiotics to treat the infection.
You’re Symptom-Free (Yep—Scary)
Before you declare this unhelpful and irrelevant to you, it’s important to be aware that most STIs have no symptoms at all, says Dr. Streicher. That’s why it’s all the more important to ask your gynecologist for screenings at your annual exam. “The biggest misconception is that people think that their gynecologist automatically does this testing during your pap. They don’t, and there’s no universal guideline for what to screen for,” she adds. So bring it up yourself and ask to be tested for STIs. Tell your doc about anything you’re concerned about (like, “I was with this guy who…”), which will help him or her figure out which tests you need.
6 Surprising Facts About STDs
If you have sex — or are planning to — you should read this
How much do you know about sexually transmitted diseases (STDs)?
Probably more than your parents and grandparents did back when STDs were called venereal diseases.
Still, according to Marsha Gorens, MD, a gynecologist at Rush University Medical Center, even some of today’s savviest adults might be surprised when they hear these facts:
1. More than 25 different diseases can be transmitted sexually.
“I don’t think people realize just how many different infections they’re exposing themselves to when they have unprotected sex,” Gorens says.
That’s why she recommends that all sexually active adults ask their primary care physician or gynecologist for annual STD testing.
2. STDs among older adults are on the rise.
“For older adults, life changes like divorce and finding new partners create potential for exposure,” Gorens says.
Once past childbearing years, older adults entering into new sexual relationships simply may not realize they should always use condoms — to avoid STDs rather than unplanned pregnancies.
3. Some STDs — including chlamydia and gonorrhea, which have no symptoms — can affect fertility.
“An untreated STD can lead to pelvic inflammatory disease (PID), an infection that can scar the fallopian tubes,” Gorens says.
Such scarring can either prevent an egg from becoming fertilized or keep a fertilized egg from reaching the womb. STDs can compromise male fertility too, though more rarely.
4. Condoms don’t provide 100 percent protection from the most common STD: genital herpes.
“Condoms cover only the penis, but we see herpes sores in places outside the covered area, like on thighs and buttocks,” Gorens says. And contact with any herpes sore — anywhere — can lead to infection. “Receiving oral sex from someone who has a cold sore on the mouth can cause a genital herpes infection.”
So whether your partner is a man or a woman, you could still be exposed to herpes even if you don’t engage in genital sex. Although herpes cannot be cured, medications can reduce symptoms and make it less likely for an infected person to spread the disease.
5. Any sexual activity — not just intercourse — can spread STDs, including one that can cause cancer.
Oral and anal sex and mutual masturbation can expose people to a number of STDs besides herpes, including chlamydia, syphilis and human papillomavirus (HPV). And it’s HPV that’s usually linked to cancer.
“Not only can HPV cause cervical cancer — it can also cause anal, throat and penile cancer,” Gorens says.
HPV vaccinations can help protect today’s tweens and teens from getting cancer in the future. Read a pediatrician’s perspective on the HPV vaccine.
6. Most people who have herpes have no, or very mild, symptoms.
That’s why Gorens recommends that new partners both get tested. And make sure it’s a blood test.
“You can’t just look for sores; they may or may not be there at the time,” she says.
Test for the top 7 STDs
Gorens recommends yearly testing for the seven most common STDs:
- Chlamydia and gonorrhea: They can lead to pelvic inflammatory disease.
- Hepatitis B and hepatitis C: They can damage the liver.
- Herpes: It causes outbreaks of painful sores.
- HIV: It compromises immune function and can lead to AIDS.
- Syphilis: It begins with painless open sores but eventually damages organs and can be fatal.
Worry and anxiety
You may be concerned about a sexual contact and your chances of passing on or getting an STI, or you may be anxious about having an STI and how that will affect your health, relationships or sex life. You may worry about the stigma or shame around some STIs. Some people feel more anxious when they step out of their comfort zone such as having sex with a sex worker, having sex with someone other than a regular partner or trying some new sexual activity. Another time that is often difficult for people is waiting for test results once you have been tested.
Worry can show up in many ways, including:
- Physical symptoms: rapid heart rate, headaches, chills, nausea, fatigue
- Thoughts: confusion, uncertainty, poor concentration, poor memory, intrusive thoughts
- Emotions: fear, guilt, panic, anxiety, irritability, depression, agitation,
- Behaviour: withdrawal, problems sleeping, changes in social activity, appetite or alcohol/drug use, difficulty working
When worry is not helpful
Worry is a problem when it becomes hard to control and starts to get in the way of your daily life. Obsessive worry is like a downward spiral; the longer you spend thinking about it, the more anxious you can become. A common example of worry is when your STI or HIV tests are negative but you continue to feel anxious or uneasy. You may find yourself looking for more information and getting tested again and again. But worry is an emotion that causes the mind to overthink and often there is no amount of information that will lessen the anxiety.
Worry can be a problem, but it can also be useful. It is often a sign that you are uncomfortable with something that has happened and it gives you a chance to think about what is worrying you and if you want to make changes. Here are some questions you can think about if you are feeling a lot of worry:
- Do you need to look at your comfort level: Everyone has a different level of “risk tolerance” or comfort with sexual activity. Over time, you will learn what you are OK with. If you have sex and it causes you a lot of worry, then you might want to think how you could do things differently next time. For example, if you find you are worrying about a blow job without a condom, you may think about using condoms the next time.
- Do you have good information: Have a look at our “Know your chances” tables for information on your chances of getting or passing an STI with different types of sex.
- Do you have worry in other parts of your life: Is this your only anxiety right now? If you are worried about one thing, it can often lead to worrying about other things. If you are more and more anxious about your chances of getting an STI, then you may want to think about other worries in your life that are adding to that stress.
- Is it time to talk to a counselor: Sometimes it helps to talk to someone who has experience helping people deal with anxiety. If your feelings are making it hard to get by day-to-day, then it might be helpful to talk to a professional counselor. See the list of services in the resources section below.
What you can do
It can help to remember that worry and anxiety are emotional issus and there are things you can try that can help you manage your emotions when you are worrying a lot.
- Stop looking for more answers on the internet: Searching the internet for information can often make your anxiety worse because it is full of information that is outdated or incorrect. Getting the wrong information can increase your worry.
- Try deep breathing and breath counting: Bring your attention to your breath; breathe in through your nose and out through your mouth. As you breathe in, push the air down deep into your stomach. Slow down and count the rhythm of your breath.
- Affirmations: Affirmations are simple statements to focus your mind, help you stay calm, and reduce negative emotions. For example, “I am worried, but I can be calm”, or “I am worried, but the doctor said I was fine”. It can help to combine affirmations with deep breathing.
- Thought stopping: Thought stopping will give you control over negative thoughts. When you become aware that you are worrying, say STOP in your mind or even out loud, if it’s appropriate.Take a deep breath and visualize yourself gathering up negative thoughts and blowing them out with your breath, say to yourself: “blow it away” or “let it go, take another deep breath and say your affirmation.
- Make a worry plan: Write out these strategies on a business card that you keep in your wallet or nearby so it is easy to find when you need it. The worry plan reminds you what you can do.
When I am Worried I Will
- Stop searching the internet
- Deep breathe and count
- Thought stop
- Say an affirmation
Here to Help
Crisis Centre of BC
BC Association of Clinical Counselors
Family Services of Greater Vancouver
Oak Counseling Services
UBC Psychology Clinic
Qmunity free counseling for members of the GLBTQ communities
- Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum.
- Syphilis is curable with antibiotic treatment.
- Syphilis is spread through sex: vaginal, anal, and oral.
- Syphilis is a “skin-to-skin” disease. It can be transmitted when a sore or other syphilis lesion of a sex partner rubs against a tiny cut or opening in the skin.
- Syphilis makes it much easier to get and give HIV.
- Many people don’t notice syphilis symptoms or know they have syphilis.
- The initial sore caused by syphilis is painless, and if the sore is inside the body (inside the penis, rectum, vagina, or mouth) it can’t be seen.
- People with HIV and syphilis may be at higher risk for neurosyphilis (syphilis of the brain and spinal cord).
- During pregnancy syphilis can be passed from mother to infant in utero through the placenta.
- Syphilis can cause damaging complications or kill babies if it is transmitted to them.
- Untreated syphilis can cause serious or fatal damage to the brain and heart, can paralyze, and can seriously damage the bones, nerves, liver, blood vessels, eyes, and joints, and other internal organs of an infected person.
The Nine Myths of Syphilis
Make Sure You Can Separate Fact from Myth When It Comes to Syphilis
Earlier this year, Medicare Health Plans, a consortium of Medicare supplement insurers, looked at Internet searches to find out which health conditions were most Googled by state. Among the top search items was syphilis.
That is surprising, but not too surprising. Sexually transmitted diseases may be searched more because they are so little discussed. You’;re not likely to ask your friends for advice about syphilis. But as we know, online searches can bring up questionable if not outright incorrect information.
When it comes to something like syphilis, it is important to separate the facts from the myths to protect yourself and your loved ones. Here are some of the more common myths about syphilis.
MYTH #1: Syphilis is a thing of the past.
Since 2001, according to the Centers for Disease Control, the reported cases of syphilis increased from 2.1 cases per 100,000 population to 9.5 cases per 100,000 population in 2017. In fact, the number of syphilis case has increased almost every year since 2000–2001.
MYTH #2: Syphilis is a heterosexual disease.
Since 2000, the rise in the rate of reported syphilis has been primarily attributable to increased cases among men and, specifically, among gay, bisexual, and other men who have sex with men.
However, it should be also noted that within the last five years, cases among women and men who have sex with women have increased as well. The increase in syphilis among women is of particular concern because it has been associated with an increase in syphilis passed from pregnant women to their unborn babies.
MYTH #3: Syphilis can’;t be spread through oral sex.
You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Syphilis can also spread from an infected mother to her unborn baby.
MYTH #4: Syphilis is easily spotted.
Unfortunately, some people can have syphilis for a long time and not know it. (See the signs and symptoms in the sidebar.) It may not be obvious that your sex partner has syphilis because syphilis sores can be hidden in the vagina, anus, under the foreskin of the penis, or in the mouth.
The only way to know for sure is a test at your doctor’;s office. Most of the time, a simple blood test is used to test for syphilis.
MYTH #5: Syphilis is incurable.
Syphilis can be cured with antibiotics from your health care provider.
MYTH #6: Syphilis is not dangerous.
Although it is sometimes without symptom, if left untreated, syphilis can spread to the brain and nervous system or to the eye, causing permanent nerve damage or blindness. For pregnant women, it is also potentially deadly to their unborn child.
MYTH #7: The cures today can undo any damage caused by syphilis.
Although syphilis is relatively easy to cure, the treatment might not undo any damage that the infection has already done.
MYTH #8: I’;ve had syphilis, so I can’;t get it again.
Having syphilis once does not protect you from getting it again. Even after you’;ve been successfully treated, you can still be re-infected.
MYTH #9: I’;m not promiscuous. I can’;t get syphilis.
If you are sexually active, you can get syphilis. The only way to avoid syphilis, or any sexually transmitted infection (STI), is to not have vaginal, anal, or oral sex.
If you are sexually active, the Centers for Disease Control (CDC) offers two tips to lower your risk of getting syphilis:
Be in a long-term mutually monogamous relationship with a partner who has been tested for syphilis and does not have syphilis;
Use latex condoms the right way every time you have sex.
Screenings are an important tool if you are sexually active and at a high risk. The CDC offers a schedule of recommended STI screenings, outlining who should get them and when. Your primary care provider can also provide guidance on the screenings you should have.
If you have questions, or would like to be tested for STIs, talk to your family physician. You can find a UPMC Pinnacle family physician near you at UPMCPinnacle.com/PrimaryLocations.
What Are the Signs and Symptoms of Syphilis?
According to the Centers for Disease Control and Prevention, the symptoms of syphilis in adults vary by stage:
You may notice a single sore or multiple sores at location where syphilis entered your body. The sores are usually (but not always) firm, round, and painless. Because they’;re painless, you may not notice them. The sores usually lasts three to six weeks and will heal with or without treatment.
At this point, you may have skin rashes and/or mucous membrane lesions. Mucous membrane lesions are sores in your mouth, vagina, or anus. The rash can look like rough, red, or reddish-brown spots on the palms of your hands and/or the bottoms of your feet. It usually won’;t itch and it is sometimes so faint that you won’;t notice it. You may also feel a fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue (feeling very tired). The symptoms from this stage will go away whether or not you receive treatment.
The latent stage of syphilis is a period of time when there are no visible signs or symptoms of syphilis. If you do not receive treatment, you can continue to have syphilis in your body for years without any signs or symptoms.
Most people with untreated syphilis do not develop tertiary syphilis. However, when it does happen it can affect many different organ systems. These include the heart and blood vessels, and the brain and nervous system. Tertiary syphilis is very serious and would occur 10 to 30 years after your infection began. In tertiary syphilis, the disease damages your internal organs and can result in death.
Syphilis is caused by a bacteria called Treponema Pallidum. Like similar bacterially caused STDs, it is spread from person to person via body fluids, most commonly via unprotected sexual activity, but occasionally when infected sores come into contact with open cuts or scrapes.
A Syphilis infection passes through three identifiable stages with each stage having a recognizable profile of symptoms. The first stage of infection is characterized by the presence of painless ulcers (moist breaks in the skin) known as “chancres”. The chancres heal on their own. Within several weeks to months 25% of infected people go on to develop symptoms characteristic of the secondary stage of syphilis infection, while the other 75% of infected people will have a silent (symptom-free) but continuing infection. When secondary stage syphilis symptoms are present, they include rash, fever, headache, swollen lymph nodes, loss of appetite, and tiredness. When a rash occurs, it is generally found on the palms of the hands and the soles of the feet.
Whether secondary symptoms are present or not, people infected with syphilis are likely to go on to experience a third stage of symptoms, sometimes referred to as “late syphilis”. Third stage syphilis is a very serious medical condition, which can develop anytime between one and thirty years after initial infection. Third stage syphilis affects the nervous system, the heart, the skin and the bones, and can lead to destruction of important organs, such as the liver and brain. In the brain, third stage syphilis can lead to memory problems, mood changes and dementia, resulting in the need for nursing home care. Third stage syphilis can even cause death by affecting the vital organs.
If you suspect you may have syphilis, it is vitally important that you see your doctor as soon as possible for testing and treatment. Doctors can do a blood test to detect the presence of the syphilis bacteria. They can treat syphilis with antibiotics. The earlier the disease is caught, the easier it is to treat (Later stage syphilis is difficult to treat). A single dose of penicillin (an antibiotic drug) can treat syphilis when it is at the first “chancre” stage. Alternative antibiotics are available for patients who are allergic to penicillin. Your doctor may retest your blood to make sure it is free of syphilis bacteria once the antibiotic treatments are completed. Needless to say, people with active chancres or other symptoms of syphilis should not have sex until they have been treated for the disease and cleared by their doctor.
Because of the hidden and lethal dangers that syphilis poses for untreated infected persons, it is vital that you contact your recent sex partners, tell them of your syphilis infection, and urge them to see their doctor for testing and treatment. You may be saving your partner’s lives by doing so. It is possible that one or more of your partners has had syphilis for years and has never shown recognizable symptoms.
As with other STDs, you can reduce your chances of becoming infected with syphilis by taking precautions with your sexuality. Abstain from sexual contact entirely, or only have sex with one steady committed partner. If you must have sex with more than one partner, make sure you use barrier method contraception such as a latex condom. Note that condoms may not protect you from syphilis infection as syphilis chancres can occur in the general pubic region and not be covered by the condom. You could catch the disease if you rubbed against another person’s chancres.
STDs You Should Know
STDs You Should Know More About
Below is a list of sexually transmitted diseases that have high rates of infection or can cause severe medical complications, including death and infertility.
Chlamydia: Chlamydia is a bacterial infection that can be easily treated with medication. Since chlamydia does not have symptoms, you may not know you have it. Approximately 75% of women and 50% of men do not have symptoms. In women, chlamydia can cause pelvic inflammatory disease (PID), which can result in infertility, chronic pelvic pain, or tubal pregnancies. In men, it can cause urethral infection or swollen testicles.
For more information on chlamydia go to:
- American Social Health Association (ASHA)
- National Institute of Allergies and Infectious Diseases
Gonorrhea: Gonorrhea is a bacterial infection that is treatable, if detected early. Common symptoms are a discharge from the vagina or penis and painful or difficult urination. About half of gonorrhea infections in women do not have symptoms. Gonorrhea can result in PID (see below), if not treated.
For more information on Gonorrhea go to:
HIV/AIDS:The Human Immunodeficiency Virus, or HIV, is the virus that causes AIDS, the Acquired Immune Deficiency Syndrome. Over 1.1 million people in the United States are living with HIV, and almost a fifth (18.1%) of HIV infected Americans are unaware of their status. Although there have been major advances in the prevention and treatment of HIV, we continue to see too many new HIV infections and too many AIDS deaths. For these reasons, a general understanding of HIV is essential to public health.
Basic Information About HIV/AIDS
Pelvic Inflammatory Disease (PID): Pelvic Inflammatory Disease is caused by a variety of organisms, most commonly chlamydia and gonorrhea, and is an infection of the upper genital tract. The more sexual partners you have the greater the risk of contracting PID. Pelvic inflammatory disease can result in infertility, chronic pelvic pain, or tubal pregnancies.
For more information on PID go to:
Syphilis: Syphilis is a bacterial STD that can be treated with antibiotics. Syphilis is an incubating disease that left untreated can cause mental illness, blindness and death. Symptoms of syphilis can include an ulcer or chancre, mild fever, fatigue, headache, or rash.
For more information on Syphilis go to:
Other STDs: There are many other STDs including: genital warts, human papillomavirus (HPV), and genital herpes. For more information on other STDs, you can go to the following web sites:
Syphilis had become relatively rare in developed countries since the discovery of penicillin, though it continues to plague many parts of the global South. At the turn of the millennium, it looked as though the United States had all but eliminated the disease. After an outbreak in the early 1990s, diagnoses of primary and secondary syphilis had dropped to 2.1 cases per 100,000 people—the lowest rate since the U.S. began recording it in 1941. But in 2002, the downward trend began to reverse.
The new wave of syphilis shows no signs of slowing down. In New Orleans, the number of syphilis cases tripled between 2012 and 2014. Central New York, which two years ago reported 27 syphilis cases, most recently reported 110, and some health clinics are now offering free syphilis testing. Health officials in Oregon, where syphilis rates have increased by more than 1,000 percent from 2007 to 2014, have created a new website, syphaware.org. The site’s homepage reads, “Oregon is known for many things: natural beauty, coffee, beer, and Pinot Noir. Did you know that Oregon is also known for syphilis?”
Researchers are still trying to work out why these increases are happening now, but the CDC’s report offers a few clues. For one, syphilis isn’t the only sexually transmitted disease becoming more common. Syphilis, chlamydia, and gonorrhea—the three STDs that comprised the focus of the report—rose simultaneously for the first time on record, which suggests an underlying cause that isn’t syphilis-specific.
Some health officials point to the growing role of technology in people’s sex lives, specifically apps like Tinder and Grindr that facilitate casual sex between partners who don’t know each other’s sexual histories. But there’s no conclusive evidence that these apps have played a role in syphilis outbreaks, especially given that Tinder was released more than a decade after syphilis rates began rising again in 2002.
Sarah Kidd, an epidemiologist at the CDC, believes dating apps can pose a diagnostic problem, since controlling the spread of syphilis relies on being able to notify an infected person’s sexual partners.“We do know that with the rise of so many apps, it’s easier to meet partners and not necessarily have identifying information and not be able to track them down later,” she says.
Compared to chlamydia and gonorrhea, syphilis is particularly challenging from a public-health perspective because most Americans don’t think of it as a threat. The worst epidemics happened centuries ago, when the infection had no known cause or cure. In the early 16th century, the Italian physician Alexander Benedictus suggested that syphilis was spread through “a venereal taint produced in the sexual organs of women by the alteration of humors which they exhale.”
A poster from Britain’s wartime
campaign against venereal
disease in 1943-1944 (Wikimedia)
Across the world, people also blamed foreigners for bringing syphilis into their countries. In his book Opus Ultimum, Daniel N. Leeson writes: “The English called syphilis ‘The French Disease’; the French called it ‘The Italian Disease’; the Italians called it ‘The Turkish Disease’; the Russians called it ‘The Polish Disease’; and both the Japanese and the Indians termed it ‘The Portuguese Disease.’ Only the Spanish accepted any blame, referring to it as ‘The Spanish Disease.’” (They may have had good reason. Some historians believe that Columbus and his crew brought the infection from America upon returning to Europe, though that theory was challenged just last week when researchers found signs of congenital syphilis in the skeleton of a European child who died in the 14th century.)
Everything You Need to Know About Syphilis
French novelist Guy de Maupassant was said to have written some of his most disturbing works while in the throes of syphilis that had gone to his brain. He also attempted suicide by ramming a paper knife into his throat, and then ended up in a mental institution.
For a disease often associated with male artists of 19th-century France, syphilis appears to be having a 21st century renaissance. An STD caused by the bacteria treponema pallidum, syphilis has recently been on the rise in the US—the incidence increased from 2.1 cases per every 100,000 of the population in 2001 (an all-time low since data collection began in 1941) to 7.5 in 2015. Around 90 percent of cases occur in men, and the largest increases have been found among men who have sex with men.
Women haven’t been entirely spared. From 2014-2015, the rate of infection increased by 18.1 percent among men and 27.3 percent among women, which also increased the risk of congenital syphilis in babies. And while the country saw an overall increase that year, western and southern states were disproportionately affected, with Louisiana reporting the highest incidence rate (15 per 100,000), followed by Georgia (14), and then California (12.6).
Vintage Med Stock / Getty Images
How will I know if I have syphilis?
You might notice a single painless sore that lasts three to six weeks but doesn’t hurt. The sore is a chancre, marking the primary stage of the disease. Not long after, more pesky sores begin to pile up like last month’s bills—on your mouth, genitals, or anus. Now would be the time to seek treatment, if you haven’t already. These indicate the secondary stage, and you may get a skin rash of rough, reddish-brown spots on the palms of your hands and bottoms of your feet as well. It doesn’t itch and might be faint enough that you hardly notice. You could also experience other seemingly unrelated symptoms: swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.
How is syphilis treated?
Syphilis is pretty easy to cure, if caught in the primary, secondary, or even early latent stages, with an intramuscular injection of Benzathine penicillin.
What’s the worst case scenario?
Without treatment, your symptoms will go away. (Maupassant noted in a letter to his mother that his hair had stopped falling out.) In the latent stage, you will still have syphilis—you just won’t hear from it again for another ten to 30 years, if ever. Only 15 to 30 percent of patients who go untreated develop tertiary syphilis, known to damage internal organs, brain, nerves, heart, blood vessels, liver, bones, and joints. Oh and it causes death too.
During any of the aforementioned stages, the disease can also spread to the central nervous system (known as neurosyphilis, as in Maupassant’s case) or eye (ocular syphilis), causing paralysis, dementia, and blindness. A pregnant woman can also infect her unborn children, resulting in congenital syphilis, which may lead to dangerous complications, including stillbirth and infant death. Early prenatal care and treatment of the expectant mother lowers the risk of transmission.
How do I protect myself?
Wrap it up. Syphilis is spread via direct contact with sores, which can happen during vaginal, anal, and oral sex, so you can reduce your risk of contracting this and other STDs by using a latex condom—and making sure your partner has been recently screened. Syphilis also helps facilitate the transmission of HIV, so if you’re sexually active with multiple partners, it’s recommended that you get tested every three months. To find out your status, a doctor can test your blood or the fluid from a sore.
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